Methylphenidate: trial of discontinuation

Methylphenidate, better known as Ritalin or Concerta, is regularly prescribed in children with ADHD symptoms. There are indications that this medication becomes less effective after prolonged use. The Dutch Clinical Guidelines for ADHD (de Nederlandse Zorgstandaard ADHD) recommends to evaluate if the medication still has the desired effects at least once a year. In addition, a recent study from Accare in children who used methylphenidate for a prolonged time (the MASK study) , showed that more than half of the children (60%) did not deteriorate after withdrawing the medication and withdrawing did not result in unwanted side effects. Therefore, we want to evaluate regularly and make sure you still need the medication. 

At the start of your treatment with methylphenidate, a trial of discontinuation will be planned for when you will using the medication for about a year. The trial of discontinuation will exist of two contiguous periods of two weeks and will be done double blind. This means that you will receive a placebo (fake medication) in one period and the real medication in the other period. However, you, your parents, and your practitioner will not know when you will take the fake or the real medication. Only the pharmacy knows this. 

After the trial of discontinuation, the blind will be broken so it will become clear in which period you took the fake and real medication. With the help of the results of questionnaires and your experiences during the trial, you, your parents, and your practitioner will decide together if the medication is necessary.

Researchers will then evaluate if the trial of discontinuation is a good way to evaluate if medication is still necessary.